Our Forms Brand new Patient Forms to complete PLEASE FILL OUT ALL OF THE FORMS (Family information, Patient medical history, HIPAA/Financial agreement, Informed Consent, COVID-19) Family information (1 form per family) Patient medical history (1 form per child) HIPAA and Financial agreement form (1 form per family) Please read HIPAA information and Dental material below Informed Consent form (1 form per family) COVID-19 Screening form (1 form per child) This form is to be filled out 1-2 days prior to your child's appointment Other forms (to be filled out only if our team instructed you to do so) Non-parental consent Silver Diamine Fluoride (SDF) Information for reading Health Insurance Portability and Accountability Act (HIPAA) Dental Material First Aids for Dental Emergencies Caries balance Contact us! Call us: (707) 685-9819 ORText us: (707) 474-4543 ORFill out the form below Which is bigger, 2 or 8?
